Chapter 15. Language and Our Divided Brain

By Meeri Kim
The dangers of concussions, caused by traumatic stretching and damage to nerve cells in the brain that lead to dizziness, nausea and headache, has been well documented. But ear damage that is sometimes caused by a head injury has symptoms so similar to the signs of a concussion that doctors may misdiagnose it and administer the wrong treatment.
A perilymph fistula is a tear or defect in the small, thin membranes that normally separate the air-filled middle ear from the inner ear, which is filled with a fluid called perilymph. When a fistula forms, tiny amounts of this fluid leak out of the inner ear, an organ crucial not only for hearing but also for balance.
Losing even a few small drops of perilymph leaves people disoriented, nauseous and often with a splitting headache, vertigo and memory loss. While most people with a concussion recover within a few days, a perilymph fistula can leave a person disabled for months.
There is some controversy around perilymph fistula due to its difficulty of diagnosis — the leak is not directly observable, but rather identified by its symptoms. However, it is generally accepted as a real condition by otolaryngologists and sports physicians, and typically known to follow a traumatic event. But concussions — as well as post-concussion syndrome, which is marked by dizziness, headache and other symptoms that can last even a year after the initial blow — also occur as the result of such an injury.

By Linda Carroll
Women may have a harder time recovering from concussion, a new study suggests.
Taiwanese researchers found women were more likely than men to continue to have memory deficits nearly three months after a mild traumatic brain injury, or mTBI, according to the study published in the journal Radiology.
The findings provide "evidence that women may have greater risk for developing working memory impairment after mTBI and may have longer recovery time," said study coauthor Dr. Chi-Jen Chen, a professor at Taipei Medical University Shuang-Ho Hospital.
"According to our preliminary results, more aggressive management should be initiated once mTBI is diagnosed in women, including close monitoring of symptoms, more aggressive pharmacological treatments, rehabilitation, as well as longer follow-up."
Chen had noticed that almost twice as many women as men were showing up in her clinic after concussions. She wondered if there might be some kind of physical difference making concussions more severe in women.
To determine whether there was a real effect, she and her colleagues rounded up 30 concussed patients and 30 non-brain-injured volunteers. Each group had equal numbers of men and women. The concussed patients were scanned shortly after doing a memory test with functional MRI twice: one month after their injury and again six weeks later. The volunteers were scanned once.
All the study participants took neuropsychological tests designed to measure attention span, impulsivity, and deficits in working memory.

By Sandra G. Boodman A
Braced by her partner, Suzanne Tobin shuffled back to her car parked in the cavernous garage at Johns Hopkins Hospital late on the evening of Oct. 22, 2013, distraught about what might happen next.
Tobin, then 60, had been driven by her partner, James Rapp, from their Germantown home to the Hopkins ER in hopes that doctors there could determine what was causing her relentless deterioration. Three months earlier, Tobin had held a full-time job as a copy editor at AARP in the District. She spent an hour before work striding around the Mall for exercise. Now she could no longer walk unassisted, her speech was nearly unintelligible and her left hand was so weak she could no longer hold a book.
Doctors in suburban Maryland had diagnosed a stroke — or possibly a series of strokes — but were unable to explain why Tobin kept getting worse by the week. Her neurologist counseled patience and offered to prescribe antidepressants, drugs that Tobin had told him she had taken for years.
An occupational therapist she’d been seeing had expressed alarm; stroke patients tended to plateau or even improve over time, not to experience a steady downward spiral. “You need to get a new neurologist,” she advised Tobin.
Tobin and Rapp decided their best bet was to head to Hopkins in Baltimore. But after 12 hours and a battery of tests, including a CT, MRI and other scans, emergency physicians sent Tobin home. They found no new stroke — an earlier MRI that Rapp had brought along appeared to show an old one — nor any other problem that would require immediate hospitalization. They advised her to follow up with her regular doctors.

By Ariana Eunjung Cha
Autism has always been a tricky disorder to diagnose. There’s no such thing as a blood test, cheek swap or other accepted biological marker so specialists must depend on parent and teacher reports, observations and play assessments. Figuring out a child's trajectory once he or she is diagnosed is just as challenging. The spectrum is wide and some are destined to be on the mild end and be very talkative, sometimes almost indistinguishable from those without the disorder in some settings, while others will suffer from a more severe form and have trouble being able to speak basic words.
Now scientists believe that they have a way to distinguish between those paths, at least in terms of language ability, in the toddler years using brain imaging.
In an article published Thursday in the journal Neuron, scientists at the University of California-San Diego have found that children with autism spectrum disorder, or ASD, with good language outcomes have strikingly distinct patterns of brain activation as compared to those with poor language outcomes and typically developing toddlers.
"Why some toddlers with ASD get better and develop good language and others do not has been a mystery that is of the utmost importance to solve," Eric Courchesne, one of the study’s authors and co-director of the University of California-San Diego's Autism Center, said in a statement.
The images of the children in the study -- MRIs of the brain -- were taken at 12 to 29 months while their language was assessed one to two years later at 30 to 48 months.

Jordan Gaines Lewis
Hodor hodor hodor. Hodor hodor? Hodor. Hodor-hodor. Hodor!
Oh, um, excuse me. Did you catch what I said?
Fans of the hit HBO show Game of Thrones, the fifth season of which premieres this Sunday, know what I’m referencing, anyway. Hodor is the brawny, simple-minded stableboy of the Stark family in Winterfell. His defining characteristic, of course, is that he only speaks a single word: “Hodor.”
But those who read the A Song of Ice and Fire book series by George R R Martin may know something that the TV fans don’t: his name isn’t actually Hodor. According to his great-grandmother Old Nan, his real name is Walder. “No one knew where ‘Hodor’ had come from,” she says, “but when he started saying it, they started calling him by it. It was the only word he had.”
Whether he intended it or not, Martin created a character who is a textbook example of someone with a neurological condition called expressive aphasia.
In 1861, French physician Paul Broca was introduced to a man named Louis-Victor Leborgne. While his comprehension and mental functioning remained relatively normal, Leborgne progressively lost the ability to produce meaningful speech over a period of 20 years. Like Hodor, the man was nicknamed Tan because he only spoke a single word: “Tan.”